共查询到20条相似文献，搜索用时 62 毫秒
1.
Fangyuan Gao Qianqian Zhang Yao Liu Guozhong Gong Dewen Mao Zuojiong Gong Jun Li Xinla Luo Xiaoliang Li Guoliang Chen Yong Li Wenxia Zhao Gang Wan Hai Li Kewei Sun Xianbo Wang 《Digestive and liver disease》2019,51(3):425-433
Background
The current definitions and etiologies of acute-on-chronic liver failure (ACLF) are clearly very different between East and West.Aims
This study aimed to develop an effective prognostic nomogram for acute-on-chronic hepatitis B liver failure (ACHBLF) as defined by the Asia Pacific Association for the Study of the Liver (APASL).Methods
The nomogram was based on a retrospective study of 573 patients with ACHBLF, defined according to the APASL, at the Beijing Ditan Hospital. The results were validated using a bootstrapped approach to correct for bias in two external cohorts, including an APASL ACHBLF cohort (10 hospitals, N?=?329) and an EASL-CLIF ACHBLF cohort (Renji Hospital, N?=?300).Results
Multivariate analysis of the derivation cohort for survival analysis helped identify the independent factors as age, total bilirubin, albumin, international normalized ratio, and hepatic encephalopathy, which were included in the nomogram. The predictive value of nomogram was the strongest compared with CLIF-C ACLF, MELD and MELD-Na and similar to COSSH-ACLF in both the derivation and prospective validation cohorts with APASL ACHBLF, but the CLIF-C ACLF was better in the EASL-CLIF ACHBLF cohort.Conclusions
The proposed nomogram could accurately estimate individualized risk for the short-term mortality of patients with ACHBLF as defined by APASL. 相似文献2.
Marcio Nucci Paula Rocha Braga Simone A. Nouér Elias Anaissie 《The Brazilian journal of infectious diseases》2018,22(6):455-461
Background
The impact of central venous catheter (CVC) removal on the outcome of patients with candidemia is controversial, with studies reporting discrepant results depending on the time of CVC removal (early or any time during the course of candidemia).Objective
Evaluate the effect of time to CVC removal, early (within 48 h from the diagnosis of candidemia) vs. removal at any time during the course of candidemia, on the 30-day mortality.Methods
Retrospective cohort study of 285 patients with candidemia analyzing CVC removal within 48 h (first analysis) or at any time (second analysis).Results
A CVC was in place in 212 patients and was removed in 148 (69.8%), either early (88 patients, 41.5%) or late (60 patients, 28.3%). Overall, the median time to CVC removal was one day (range 1–28) but was six days (range 3–28) for those removed later. In the first analysis, APACHE II score (odds ratio [OR] 1.111, 95% confidence interval [95% CI] 1.066–1.158), removal at any time (OR 0.079, 95% CI 0.021–0.298) and Candida parapsilosis infection (OR 0.291, 95% CI 0.133–0.638) were predictors of 30-day mortality. Early removal was not significant. In the second analysis APACHE II score (OR 1.122, 95% CI 1.071–1.175) and C. parapsilosis infection (OR 0.247, 95% CI 0.103–0.590) retained significance.Conclusions
The impact of CVC removal is dependent on whether the optimal analysis strategy is deployed and should be taken into consideration in future analyses. 相似文献3.
Ujjwal Sonika Shekhar Jadaun Gyan Ranjan Gyanranjan Rout Deepak Gunjan Saurabh Kedia Baibaswata Nayak Shalimar 《Indian journal of gastroenterology》2018,37(1):50-57
Background and Aims
Various prognostic scores are available for predicting outcome in acute-on-chronic liver failure (ACLF). We compared the available prognostic models as predictors of outcome in alcohol-related ACLF patients.Methods
All consecutive patients with alcohol-related ACLF were included. At admission, prognostic indices-acute physiology and chronic health evaluation score (APACHE II), model for end-stage liver disease (MELD), MELD-Na, Maddrey’s discriminant function (DF), age-bilirubin-INR-creatinine (ABIC), and Chronic Liver Failure Consortium (CLIF-C) ACLF score (CLIF-C ACLF) score were calculated. Receiver operator characteristic (ROC) curves were plotted for all prognostic scores with in-hospital, 90-day, and 1-year mortality as outcome.Results
Of the 171 patients, 170 were males, and grade 1 ACLF in 20 (11.7%), grade 2 in 52 (30.4%), and grade 3 in 99 (57.9%) patients. One hundred and nineteen (69.6%) died in-hospital. The median (IQR) Maddrey’s score, MELD, MELD-Na, ABIC, APACHE II, and CLIF-C ACLF were 87.8 (66.5–123.0), 33.1 (27.6–40.0), 34.4 (29.5–40.0), 8.5 (7.3–9.6), 15 (12–21), and 51.1 (44.1–56.4), respectively. On multivariate Cox regression analysis, independent predictors of in-hospital outcome were presence of hepatic encephalopathy (early HR, 2.078; 95%CI, 1.173–3.682, p?=?0.012 and advanced, HR, 2.330; 95% CI, 1.270–4.276, p?=?0.006), elevated serum creatinine (HR, 1.140; 95% CI, 1.023–1.270, p?=?0.018), and infection at admission (HR, 1.874; 95% CI, 1.160–23.029, p?=?0.010). On comparison of ROC curves, APACHE II and CLIF-C ACLF AUROC were significantly higher than MELD, MELD-Na, DF, and ABIC (p?<?0.05) for predicting in-hospital, 90-day, and 1-year mortality. The AUROC was highest for APACHE II followed by CLIF-C ACLF (Hanley and McNeil, p?=?0.660).Conclusions
Alcohol-related ACLF has high in-hospital mortality. Among the available prognostic scores, CLIF-C ACLF and APACHE II perform best.4.
Felipe F. Tuon Maria Esther Graf Alexandre Merlini Jaime L. Rocha Suellen Stallbaum Lavinia N. Arend Roberto Pecoit-Filho 《The Brazilian journal of infectious diseases》2017,21(1):1-6
Background
The ideal therapeutic option for ventilator associated pneumonia caused by carbapenem-resistant Enterobacteriaceae is not defined. The aim of this study was to assess mortality-associated risk factors in patients with VAP by CRE and determine the outcome of several treatment options.Methods
This was a retrospective study performed in two tertiary hospitals involving patients with VAP caused by CRE between January 2010 and August 2014. The outcomes were mortality within 30 days of VAP diagnosis and overall mortality during hospital admission. Risk factors for mortality were assessed by comparing variables of survivors and non-survivors.Results
One hundred and twelve patients with CRE-VAP were included, 73 (65%) male, median age 56 years. The 30-day mortality was 57.1% and the overall hospital mortality was 67%. In the binary logistic regression analysis, only age >50 years was independently associated to increased mortality. Polymyxin was the most used drug (47.5%), followed by tigecycline (29.2%) and aminoglycosides (2.4%). Combined therapy with two active drugs was used by 17 patients (20.8%). No therapeutic option was independently associated to survival. However, combined therapy with two active drugs was superior to the therapy with a single active drug when inappropriate therapy was the comparator (p = 0.044). The addition of carbapenem was not associated with increased survival.Conclusion
The best therapeutic option for VAP by CRE is still not completely defined, but the therapy with at least two active drugs was superior in this study. 相似文献5.
6.
Margalida Calafat Triana Lobatón Míriam Mañosa Laura Marín Noemí Caballero Macarena Larraín Eduard Cabré Eugeni Domènech 《Gastroenterologia y hepatologia》2017,40(10):663-668
Background
Ulcerative proctitis (UP) presents distinctive clinical characteristics, outcomes and therapeutic approaches as compared to left-sided and extensive ulcerative colitis (UC).Aim
To describe the current therapeutic requirements and clinical outcomes in patients with active UP.Methods
Retrospective observational study conducted in a referral IBD centre. Patients with UP in follow-up between 1989 and 2014 were included. The clinical characteristics, as well as the different treatments and drug formulations administered to treat flares, were recorded.Results
Out of 687 UC patients, 101 patients (15%) with UP were included. Median follow-up was 8 years (IQR 3–14) and 49% of patients presented disease activity during the study period. Topical mesalazine monotherapy (90%) was the most commonly administered treatment for disease activity (mostly as suppositories), followed by topical steroids (47%) and oral mesalazine (56%) in monotherapy or combination therapy. Only 14% and 16% of patients required oral prednisone and beclomethasone, respectively.Conclusions
In clinical practice, active UP presents mostly favourable outcomes. Mesalazine suppositories are by far the most used treatment for these patients. 相似文献7.
《Annals of hepatology》2018,17(3):403-412
Introduction and aim. Multiple prognostic scores are available for acute liver failure (ALF). Our objective was to compare the dynamicity of model for end stage liver disease (MELD), MELD-sodium, acute liver failure early dynamic model (ALFED), chronic liver failure (CLIF)-consortium ACLF score and King’s College Hospital Criteria (KCH) for predicting outcome in ALF.Materials and methods. All consecutive patients with ALF at a tertiary care centre in India were included. MELD, MELD-Na, ALFED, CLIF-C ACLF scores and KCH criteria were calculated at admission and day 3 of admission. Area under receiver operator characteristic curves (AUROC) were compared with DeLong method. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and diagnostic accuracy (DA) were reported.Results. Of the 115 patients included in the study, 73 (63.5%) died. The discrimination of mortality with baseline values of prognostic scores (MELD, MELD-Na, ALFED, CLIF-C ACLF and KCH) was modest (AUROC: 0.65-0.77). The AUROC increased on day 3 for all scores, except KCH criteria. On day 3 of admission, ALFED score had the highest AUROC 0.95, followed by CLIF-C ACLF 0.88, MELD 0.81, MELD-Na 0.77 and KCH 0.52. The AUROC for ALFED was significantly higher than MELD, MELD-Na and KCH (P < 0.001 for all) and CLIF-C ACLF (P = 0.05). ALFED score > 4 on day 3 had the best sensitivity (87.1%), specificity (89.5%), PPV (93.8%), NPV (79.1%), LR positive (8.3) and DA (87.9%) for predicting mortality.Conclusions. Dynamic assessment of prognostic scores better predicts outcome. ALFED model performs better than MELD, MELD, MELD-Na, CLIF-C ACLF scores and KCH criteria for predicting outcome in viral hepatitis-related ALF. 相似文献
8.
H. Kassem K. Khamadi C. Farrugia N. Ho Hio Hen T. El Gharbi L. Turner 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(8):555-557
Introduction
Cytomegalovirus-associated thrombosis has been extensively reported in the medical literature, mainly in immune-compromised patients. However, the association with splenic infarcts has rarely been reported.Case report
We report a 32-year-old Caucasian and immunocompetent woman who presented with a splenic infarction during a primary infection with CMV. The differential diagnostic ruled out embolic, hematologic, gastrointestinal and coagulation disorders. The outcome was favorable with symptomatic treatment.Conclusion
A primary infection with CMV must be added to the diagnostic work-up in the presence of a febrile splenic infarction, especially when it is associated with a biological mononucleosis reaction. 相似文献9.
Yuji Fujikura Toshie Manabe Akihiko Kawana Shigeru Kohno 《Archivos de bronconeumología》2017,53(2):55-61
Introduction
The clinical benefits of adjunctive corticosteroids for Pneumocystis jirovecii (P. jirovecii) pneumonia in patients not infected with the human immunodeficiency virus (HIV) has not been evaluated by meta-analysis.Methods
We conducted a systematic review of published studies describing the effects of adjunctive corticosteroids on outcome in non-HIV P. jirovecii pneumonia patients. Two investigators independently searched the PubMed and Cochrane databases for eligible articles written in English. A meta-analysis was performed using a random-effects model for measuring mortality as the primary outcome, and the need for intubation or mechanical ventilation as the secondary outcome.Results
Seven observational studies were eligible. In these studies, adjunctive corticosteroids did not affect mortality in non-HIV patients (odds ratio [OR] 1.26; 95% CI 0.60-2.67) and there was no beneficial effect in patients with severe hypoxemia (PaO2 < 70 mmHg) (OR 0.90; 95% CI 0.44-1.83). No significant effect on the secondary outcome was observed (OR 1.34; 95% CI 0.44-4.11).Conclusions
Although the studies were observational, meta-analysis showed that adjunctive corticosteroids did not improve the outcome of P. jirovecii pneumonia in non-HIV patients. The results warrant a randomized controlled trial. 相似文献10.
J. Tahiri F. Fouyssac O. Morel A. Maatouk 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(5):337-339
Introduction
Good syndrome is a rare condition in which thymoma is associated with hypogammaglobulinemia. It is characterized by an increased susceptibility to infections.Case report
We report a woman with Good's syndrome diagnosed after severe congenital toxoplasmosis in her daughter, even though she was immunized against this infection during pregnancy.Conclusion
This presentation is very unusual by its early diagnosis and to our knowledge is the first report of parasitic infection in this syndrome. 相似文献11.
Ezatollah Fazeli Moghadam Artashes Tadevosyan Ebrahim Fallahi Reza Goodarzi 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2017,11(1):7-11
Introduction
Dietary factors can affect the coronary heart disease (CHD). Results of previous studies on the association between the diet and CHD are not consistent in different countries. There were no data on this association in Armenia.Objective
Aims of this case-control study were to evaluate the association between nutritional factors and CHD among Armenians in Yerevan.Methods
During 2010 and 2011, we randomly selected 320 CHD patients with a diagnosis of CHD less than 6 months and 320 subjects without CHD (≥30 years old) from the hospitals and polyclinics in Yerevan. Dietary intakes with 135 food items over the previous 12 months were evaluated using a semi-quantitative food frequency questionnaire.Results
After adjusting for some CHD risk factors higher intakes of polyunsaturated fatty acids (PUFA) and monounsaturated fatty acids (MUFA) were associated with a reduced risk of CHD, while this association was not witnessed for saturated fatty acids (SFA). In addition, findings indicated an inverse relation between vitamins (E, B6 and B12, folic acid) and fiber with CHD. In this population, smoking, hypertension, and metabolic syndrome (MetS) were significantly more common among patients with CHD.Conclusion
The intake of vitamins E, B6 and B12, folic acid, PUFA, MUFA and fiber appeared to be predictors of CHD, independently of other risk factors. 相似文献12.
Benito Velayos Jiménez Noelia Alcaide Suárez Guillermo González Redondo Luis Fernández Salazar Rocío Aller de la Fuente Lourdes del Olmo Martínez Lourdes Ruiz Rebollo José Manuel González Hernández 《Gastroenterologia y hepatologia》2017,40(1):10-15
Introduction
The impact of the accumulated experience of the capsule endoscopy (CE) reader on the accuracy of this test is discussed.Aim
To determine whether the negative predictive value of CE findings changes along the learning curve.Methods
We reviewed the first 900 CE read by 3 gastroenterologists experienced in endoscopy over 8 years.These 900 CE were divided into 3 groups (300 CE each): group 1 consisted of the sum of the first 100 CE read by each of the 3 endoscopists; group 2, the sum of the second 100 and groups 3, the sum of the third 100.Patients with normal CE were monitored for at least 28 months to estimate the negative predictive value.Results
A total of 54 (18%) CE in group 1, 58 (19.3%) in group 2 and 47 (15.6%) in group 3 were normal, although only 34 patients in group 1, 38 in group 2 and 36 in group 3 with normal CE completed follow up and were eventually studied.The negative predictive value was 88.2% in group 1, 89.5% in group 2 and 97% in group 3 (P > .05).Conclusion
The negative predictive value tended to increase, but remained high and did not change significantly after the first 100 when readers are experienced in conventional endoscopy and have preliminary specific training. 相似文献13.
M. Ammar F. HadjKacem A. Maalej G. Abid N. Charfi M. Abid 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(12):844-846
Introduction
Pituitary hyperplasia due to primary hypothyroidism is rare and underdiagnosed.Case report
We report an 18-year-old patient referred for a pituitary mass revealing primary hypothyroidism. Biological parameters confirmed severe primary hypothyroidism and hyperprolactinemia. Outcome was favorable with l-thyroxin supplementation resulting in TSH and prolactin levels normalization and pituitary mass resolution.Conclusion
Pituitary hyperplasia due to primary hypothyroidism, although rare, should be recognized to avoid unnecessary surgery leading to irreversible complications. 相似文献14.
S.-N. Tran Ba O. Lidove R. Dorent M. Debauchez P. Nataf M. Delahousse A. Karras L. Azeroual P. De Lentdecker M.P. Chauveheid T. Sené J.-M. Ziza 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(2):137-142
Introduction
Fabry disease is a lysosomal storage disorder linked to an alpha-galactosidase A deficiency that can lead to heart and kidney failure. There is little data about the prognosis of patients who undergo a combined heart and kidney transplantation.Case reports
Two brothers who were diagnosed with Fabry disease after the age of 30 years underwent a combined heart and kidney transplantation at respectively 49 and 42 years of age because of a severe hypertrophic cardiomyopathy with end stage renal failure. They are alive respectively 4 and 9 years after the transplantation. No recurrence of the disease in the transplanted organs has been found.Conclusion
Combined heart and kidney transplantation in Fabry disease is an efficient therapy for the cardiomyopathy and kidney failure. Its prognosis can be good when the patients are carefully selected. However, an early diagnosis is critical in order to avoid a procedure associated with a high perioperative mortality. 相似文献15.
M. Lauda-Maillen M. Catroux F. Roy-Peaud O. Souchaud-Debouverie B. El Masmouhi P. Roblot 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(10):648-655
Objectives
Describe the management of Acquired Immune Haemolytic Anaemia (AIHA) and correlate with the current guidelines published in 2009. The secondary objective was to calculate the positive predictive value of the Direct Antiglobulin Test (DAT) for the diagnosis of AIHA.Methods
A retrospective and monocentric study was performed from 2010 to 2015 based on positive DATs, identified in the French Blood Agency database or in medical files. All patients managed for initial diagnosis or relapse of AIHA were included, excluding neoplasia.Results
Six hundred and twenty-three patients had a positive DAT, 42 had non-neoplastic AIHA. Thirty-nine patients were included, 32 had warm antibodies, 5 had a negative DAT and 2 had cold antibodies. No cause was found for 46% (17/37) of the warm antibody and negative DATs AIHAs. Autoimmune disease was found in 11 cases (30%), infection in 4 cases (11%). The etiologic investigations were consistent with the guidelines in 49% of cases. Corticosteroids were first prescribed, as recommended. Second-line treatments were rituximab in 9 cases, splenectomy in 4 cases and azathioprine in 3 cases. The management of cold antibody AIHA complied with the guidelines. The positive predictive value of DATs in hospitalized population was of 14% (85/610).Conclusion
AIHA guidelines seem insufficiently applied in our center. 相似文献16.
Tonya Azevedo Duarte Joilda Silva Nery Neio Boechat Susan Martins Pereira Vera Simonsen Martha Oliveira Maria Gabriela Miranda Gomes Carlos Penha-Gonçalves Mauricio Lima Barreto Theolis Barbosa 《The Brazilian journal of infectious diseases》2017,21(3):317-324
Introduction
The Mycobacterium tuberculosis East African-Indian (EAI) spoligotyping family (belonging to lineage 1, Indo-Oceanic, defined by the region of deletion RD239) is distributed worldwide, but is more prevalent in Southeast Asia, India, and East Africa. Studies in Latin America have rarely identified EAI. In this study, we describe the occurrence of the EAI family in Brazil.Methods
EAI was identified in a systematic literature review of genetic diversity studies pertaining to M. tuberculosis in Brazil, as well as in a survey conducted in Salvador, Bahia, located in the northeastern region of this country.Results
The EAI6-BGD1 spoligotyping family and the EAI5 Spoligotype International Type (SIT) 1983 clade were the most frequently reported, with wide distribution of this particular clade described in Brazil. The distribution of other EAI spoligotyping patterns with broader worldwide distribution was restricted to the southeastern region of the country.Conclusions
EAI may be endemic at a low frequency in Brazil, with some clades indicating increased fitness with respect to this population. 相似文献17.
Laura Palau Dávila Elvira Garza-González Patricia Rodríguez-Zulueta Rayo Morfín-Otero Eduardo Rodríguez-Noriega Diana Vilar-Compte Juan C. Rodríguez-Aldama Adrián Camacho-Ortiz 《The Brazilian journal of infectious diseases》2017,21(5):530-534
Introduction
The epidemiology of Clostridium difficile infection (CDI) has changed in the last two decades. There is a lack of information regarding incidence and severity of CDI, especially in the developing world.Methods
This was a retrospective and observational study from four hospitals of three Mexican cities. Patients were diagnosed with CDI when presented with loose stools and had at least one of the following tests positive: toxins assay, real-time PCR, or an endoscopic image compatible with pseudomembranous colitis. CDI was classified according to international guidelines. Demographic and clinical data as well as information regarding total hospital admissions, total length-of-hospital stay, and other variables related to hospitalization were gathered from the epidemiology and administration departments of each hospital.Results
A total of 2050 hospital beds were analyzed with 288,171 patients hospitalized accumulating 1,576,446 days of hospitalization during the study period. The average rate of CDI per 1000 hospital-days was lower than the rates reported in the US and Europe, although in 2015 CDI rates were almost persistently above the mean rate for the study period. More than half of PCR positive patients were ribotype 027.Conclusion
Hospital rates of CDI are increasing in Mexican hospitals with a predominance of infections caused by ribotype 027. 相似文献18.
19.
M. Bobot M. Benzaquen F. Rouby D. Lebowitz J. Serratrice J.-M. Durand 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(5):344-346
Introduction
Rituximab is a chimeric anti-CD20 monoclonal antibody generally well tolerated. However, a severe but rare rituximab-related immune-toxic syndrome, associating fever, chills and thrombocytopenia can occur shortly after the infusion.Case report
We report a case of severe acute rituximab-induced thrombocytopenia with favorable outcome in a patient with chronic lymphocytic leukemia and discuss the possible underlying mechanisms.Conclusion
Despite the potential initial severity of rituximab-induced thrombocytopenia in CLL, chemotherapy should not be discontinued; tolerance might increase as the hematologic disorder is controlled. 相似文献20.
J.-R. Christen C. Soubrier E. Martinez V. Roumieu O. Darmon S. Scandaliaris L. Picou T. Cuisset A. Grados E. Bernit M. Ebbo J.-R. Harlé N. Schleinitz 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(11):769-773